Healthcare.Gov Is Broken Because Government Innovation is Broken

November 15, 2013

As Todd Park, the Obama administration's chief technology officer, and his team scramble to fulfill their promise of fixing Healthcare.gov by the end of the month, one can only hope that soon it won't be quite the “insult to Amazon” that Rep. Darrell Issa called it during Wednesday’s House Oversight Committee hearing. He has a point. The site’s development was hamstrung by bureaucratic regulations that prevented the government from hiring the right contractors to build the site, and by the rules governing how federal agencies go about acquiring and managing IT services. Both hurdles could have been cleared with the right policy measures and the congressional will to pass them, as leading innovation thinker Robert Atkinson suggested in a blog post this week.

“I’m surprised not that there’s a failure but that people are surprised there’s a failure,” says Atkinson, a member of the Department of Commerce’s Innovation Advisory Board. “There have been a lot of failures in government IT, and it’s emblematic—it’s not the fact that the government is incapable doing things, it’s that it has a hard time doing things given its constraints.”

In other words, Healthcare.gov's troubles are symptomatic of a much larger problem of congressional malaise toward new technologies. The dysfunctional site is just one example—albeit the largest and most politically consequential one—of the administration's failure to “harness new ideas and technology to remake our government,” one of the pledges President Barack Obama made this year in his inaugural address. "We cannot cede to other nations the technology that will power new jobs and new industries, we must claim its promise," he went on to say. But because new innovations require hefty investments in largely untested technologies and research programs, there is a strong incentive for politicians not to support them; there’s no guarantee they will succeed, only that they will require taxpayer dollars. So they prefer to not take the risk, even if it could lead to massive rewards down the line.

This aversion to technological risk has also prevented the United States from reversing its precipitous decline as a global leader in innovation. For four straight years the United States has dropped in the World Economic Forum’s Global Competitiveness Index because of reduced rates of investment in research and development. A 2012 Department of Commerce report identified dwindling innovation as one of six alarms for the country’s future economic outlook, warning that “federal funding for basic research has been increasing, but at a slower pace than economic growth.” The results drew upon a July 2011 Atlantic Century report (co-authored by Atkinson) that ranked the United States “second to last in rate of progress since 2000, ahead of only Italy.” The U.S. did improve in 2013, jumping from seventh place to fifth place in the WEF index. But, due to the consistent lack of political will to invest in the development of technology, Atkinson said, “I actually don’t think we’ve made a lot of progress over the last few years... There are people talking about things, there is some legislation getting introduced, but Congress doesn’t really seem willing to do these kinds of things in a rapid, sustained way.”

Todd Park probably knows this is the case, and has matched the president’s optimistic terms with talk of “unleashing the power of the private sector,” inside of the federal government—something he clearly failed to do in building the most important project of his tenure. In an interview with McKinsey & Co. last year, Park said that he'd like his legacy “to demonstrate that government can act in lean-start-up mode to make change happen, and to unleash the innovation mojo of the many talented innovators across government.” But if there is any “innovation mojo” within the administration, as of yet it seems to have only been expressed through small efforts like the new Presidential Innovation Fellows program and the reauthorization of the America COMPETES Act, neither of which are enough to bring about meaningful progress.

“You can do these interesting programs around the edges … but you really have got to go to the core of the problem, and no one’s doing that in the United States federal government at this point,” Atkinson says.

For Park to truly unleash “the power of the private sector,” he has to help the U.S. overcome what MIT’s Ethan Zuckerman has identified as its “problem with public goods.” The country currently operates under the assumption that, as Zuckerman put it, “What government services can be privatized should be, and government dollars should go only towards services, like defense, that we can’t pay for in private markets,” even if the private solutions are much less efficient.

This is why DARPA, the advanced research division of the Department of Defense, has long served as the country’s top producer of new inventions (DARPA is why we have the Internet and GPS), while most private-sector innovations take far too long to make it past federal regulations and into the market. It’s what makes Healthcare.gov look like an "insult to Amazon." It’s also why you would turn to Elon Musk, not NASA, if you wanted to tour outer space, and more critically, why people in developing countries will have to rely on Coca-Cola, not governments or international organizations, to access clean water purified by Dean Kamen’s SlingShot device.

“There’s something very odd about a world in which it’s easier to imagine a futuristic technology that doesn’t exist outside of lab tests than to envision expansion of a technology that’s in wide use around the world,” Zuckerman writes, referring to the fact that it’s more likely that Musk’s futuristic Hyperloop or a Google self-driving car could shorten his three-hour commute between Cambridge and western Massachusetts than, say, a state-funded high-speed train. “How did we reach a state in America where highly speculative technologies, backed by private companies, are seen as a plausible future while routine, ordinary technologies backed by governments are seen as unrealistic and impossible?”

Kamen has witnessed how we got to this point. Speaking at Georgetown earlier this week, the serial inventor spoke grimly of how government regulations and the systemic political aversion to technological risk have held up his genuinely life-saving inventions from entering wide distribution. Kamen warned that if the U.S. does not soon change “our current appetite for risk and reward...this country is going to be a technological backwater.”

He is best known as the inventor of the Segway, but Kamen's more recent inventions include the SlingShot and the Luke Arm, a robotic prosthesis that DARPA commissioned for the benefit of amputee veterans. He got a working prototype ready just 15 months after DARPA first approached him with the project back in 2007. Since then, it has been in clinical trials in compliance with FDA regulations, and far too few amputee veterans have been fitted with the prosthesis.

Similarly, SlingShot was completed by 2008, when Kamen demonstrated the technology on "The Colbert Report." (Colbert wanted to see whether dumping a bag of Doritos inside the machine would foil the demonstration; they did not.) SlingShot can convert nearly any liquid into perfectly drinkable water (the water it produces meets the even higher U.S. standards for use in medical injections). Kamen claims that it will eliminate 50 percent of human illnesses—many of which are caused by curable water-borne diseases. But he explained this week that when he approached the World Bank, the World Health Organization, and USAID for for help distributing SlingShot to people without access to clean water in developing countries, “They said, ‘we don’t deliver boxes. We can’t build a microeconomic system.’ ...They basically said, ‘We’re rooting for you, we can’t help you.’”

So he found a private-sector solution. Coca-Cola agreed to help him distribute SlingShot if Kamen would build them a touch-screen soda fountain. As a result, the first SlingShots are now in place in South Africa, and more are on their way to other developing countries. But years of frustration with government bureaucracy have left Kamen with a sense that America is in a dire position with regard to technology. “You can’t use technology as an excuse. You need to decide what matters, and go do it,” Kamen said. “You don’t have to understand the technology to understand how to deploy it. You wouldn’t have to be a proctologist to know that your hemorrhoids hurt, you just [know you] have to get them fixed. The rest of the world is dying, and suffering, and we shouldn’t allow that to be. [SlingShot] and technologies like that could move way more quickly than they would be now if the people that cared about policy get on with it.”

Try as Park might, the U.S. government will never be in "lean-start-up mode"—but it will have to start providing critical public goods through increasingly digitized means. For that to happen, Congress will have to become familiar with the risks of integrating federal programs with technology and be willing to learn from, and even turn to, the private sector. The administration has two choices, really: It could follow the lead of the United Kingdom, which, after bungling its own massive healthcare IT project in 2008, launched the Government Digital Service, saving at least $20 million a year. Or it could call Coke or Amazon for help, and hope for the best.